What Can Patients Do to Access Better Colon Cancer Care?

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What Can Patients Do to Access Better Colon Cancer Care? from Patient Empowerment Network on Vimeo.

What can patients do to access quality colon cancer care? Dr. Suneel Kamath shares tips on how to advocate for yourself, the importance of quality care versus convenient care, and colon cancer resources.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Why Are Colon Cancer Cases in Young People on the Rise?

Why Are Colon Cancer Cases in Young People on the Rise?

 What Are Common Colon Cancer Health Disparities?

What Are Common Colon Cancer Health Disparities?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

Transcript: 

Katherine:  

If patients feel like they’re not receiving good care or they feel like they’re being treated unfairly, what steps should they take to access better overall care?  

Dr. Kamath:  

That’s a touchy one. It makes me sad that that even happens, but it does. I would say just never be afraid to be an advocate for yourself. To me, it’s your life and the consequence of bad healthcare, unfortunately, is not going to be on those providers. It’s going to be on you. Unfortunately, I do hear from a lot of people they worry about burning bridges, or annoying someone, or angering the doctors that they’re working with. I would tell them, “Don’t worry about that.” I don’t think people need to care about my feelings or the doctor’s feelings about the situation. 

You need to make sure you’re getting the best healthcare possible. Always feel comfortable getting a second opinion, going to a bigger center. I always recommend go to the main hospitals in your area. In the U.S. especially, I think we’re too focused on convenient healthcare and not the quality of the healthcare. I would definitely advocate, even if it takes you an hour to drive downtown to Duke or Johns Hopkins in your area, or the Cleveland Clinic, or the Mayo Clinic, or whatever, it’s worth that time compared to the person who just might be five or 10 minutes from you.  

Katherine:  

Right. Are there resources available now that might be useful for people who need, want more information?  

Dr. Kamath:  

Yes, are you talking about things that they could find online or read about? It’s in terms in of accessing care or just generally about … 

Katherine:  

Yeah, accessing care.  

Dr. Kamath:  

Yeah. I think there, again, I would go back to the American Cancer Society. The other ones that are really great, too, are – for colorectal cancer, especially, there are a number of really great patient advocacy organizations. The two that are coming to mind are the Colorectal Cancer Alliance and then Fight CRC. Both of them have phenomenal resources as far as patients who have gone through the whole journey and various phases of the journey. What I love for them, too, is usually there’s somebody that can represent your area in those settings, in those support groups and whatnot.  

I definitely think they’re a great resource in helping people find out who are the best doctors in your area. How did you get connected with them? Unfortunately, we all have phone numbers online and whatnot to find us. But we all know when you call them you end up in this interminable loop, it seems like, sometimes to get an appointment. It’s hard to navigate it all. I think a lot of times these patient advocacy organizations can be great bridges to both finding who the right people are and how do you best get in with them.  

What Are Common Colon Cancer Health Disparities?

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What Are Common Colon Cancer Health Disparities? from Patient Empowerment Network on Vimeo.

What are common colon cancer health disparities? Dr. Suneel Kamath explains what a health disparity is, the groups impacted by these differences, and how the medical community addresses them in colon cancer care.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

Transcript: 

Katherine:  

Disparities in healthcare can impact a patient’s experiences and outcomes. What are some common health disparities?

Dr. Kamath:  

Yeah, there are so many. I think with colorectal cancer in particular, access is really a huge one. People who are in underserved communities, often people of color, have less access due to systemic racism in healthcare and in insurance, lack of opportunity with employment. I’ve always thought having a purely employer-based healthcare system is not the smartest idea.  

People who are often the sickest are the least able to work and the least able to maintain their health insurance. It does a disservice to our population to have thing set up that way. Yeah, I think that’s a huge barrier. I think there’s also a lot of stigma, especially amongst people of color, around colonoscopies, things to do with your colon and rectum and whatnot. I think that’s something we also need to work on, to normalize that as something that should be done regularly and that this isn’t a bad thing. It’s just something we all have to do. 

Katherine:  

Right. Well, what is being done by the medical community to address these imbalances? 

Dr. Kamath: 

I’ve really seen, I think, a legitimate push towards community outreach in the last few years. Unfortunately, we’ve known about these disparities for decades and I think a lot has been said about addressing them since the ‘80s and ‘90s.  

But to be honest with you, I don’t think very much was really done until recently. What I’ve seen is a really concerned effort to put resources into identifying what are those barriers. Where is the distrust coming from? Who are trusted sources in your community? We’re tapping into pastors and preachers and the barbershop guy. You don’t ask people, “Who do you trust to get your information from?” If you don’t ask the question you’re never going to know. 

Recently, I think we’ve actually really done the work to find out what is going to motivate you to get something done? What’s going to make it feel normal to you and having trust healthcare? We’re seeing a lot more engagement, I think, as a result of that.  

Katherine:  

Are members of the medical community going out into the African American community to find out who they should be talking to?  

Dr. Kamath:  

We have been, actually. I reviewed a grant – just to speak of Cleveland Clinic in particular, a couple of years ago that the project that is being funded by it is still ongoing. Basically, we conducted focus groups of people at church. After the service was done, we conducted a focus group to ask them, “What are your thoughts about screening?” It was for colon cancer and for others as well. “What are your thoughts about this? What are your fears about it? What are things we could do to make you feel more comfortable with accessing this part of your care? Who do you go to to get trusted information?”  

As a result of that, doing it in their community, in the church setting where they feel safe and comfortable, we saw significant spike in the number of people who came for colonoscopies, for mammograms. We do PSA testing there and we set up a lab there. We found a big spike in the number of people who got those things done and we identified quite a few people who had cancer at early stages and we were able to cure them at much earlier stages than otherwise.  

What Is the Role of Genetic Testing in Colon Cancer Care?

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What Is the Role of Genetic Testing in Colon Cancer Care? from Patient Empowerment Network on Vimeo.

Dr. Suneel Kamath discusses the role of genetic testing in managing colon cancer. From understanding hereditary mutations to the significance of family history, learn why awareness is important.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Are Common Colon Cancer Health Disparities?

What Are Common Colon Cancer Health Disparities?

Transcript: 

Katherine:

Where does hereditary testing or genetic counseling come in as a screening tool? 

Dr. Kamath:

Hereditary testing, I think, is so important. I wouldn’t say it’s the best screening tool. It’s often best once somebody has already been diagnosed and you know that the disease is in the family. I do think it’s really, really important for people who have a family history of any cancer. Again, I go back to the fact that I think a lot of us don’t really know our family histories. I find for a lot of people when they’re first diagnosed with a cancer, that’s the first time they go talk to Mom and Dad, and to Uncle Joe Aunt Shirley, and they say, “Hey, do we have anything like this in the family?” 

And it actually turns out – I often hear the second and third visits, “It actually turns out I do have a strong family history of cancer.” I just urge people that it’s not an easy thing to talk about, but have that conversation with your family. Also, be open to sharing that information if it was you because these things have heavy implications on everyone in your entire family.  

Also, importantly, it doesn’t have to be the same cancer. A lot of people think it’s only if you have a family history of colorectal cancer that you might be at increased risk of others. But there are many syndromes that link uterine with colorectal and stomach and breast and whatnot. Being aware of any family history of cancer can really help us trigger the right genetic testing to find out if you have a hereditary syndrome or not.  

What Are Colon Cancer Screening Guidelines?

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What Are Colon Cancer Screening Guidelines? from Patient Empowerment Network on Vimeo.

What are the guidelines for colon cancer screening? Dr. Suneel Kamath explains the current recommendations, including the appropriate screening age and reviews risk assessment based on factors such as family history and race. 

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

 What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

Transcript: 

Katherine:  

It seems like the suggested ages for screening may vary based on gender and race and family history. What are the current screening guidelines?

Dr. Kamath:

The current screening guidelines that are unfortunately due this rise, there is now recommendation for starting colon cancer screening at age 45. That’s really for everybody. There are certain people that really should be screened even earlier. We definitely know that the black community is affected at a higher rate. There are some professional societies, like the AGA or ACG, that actually recommend starting even earlier in the black community, maybe even by age 40. 

And then, the other thing I always try to emphasize is with this is the usual screening guidelines that we talk about are for what we call the average risk population. I do think that we overestimate how many people are average risk. One of the things that I think is not talked about as much is that if you have a family history of even polyps – high risk polyps – that also means that your family members should get screened earlier, 10 years earlier, than the age that you were found to have a high-risk polyp.  

But my experience has been most people don’t share with their families that they had those. Let’s say I had a colonoscopy done one day and they found those, they get taken out, and they just say, “Oh, come back in three years,” instead of 10. As far as I’m concerned, that’s where it ends. But actually, the fact that I had those polyps has implications for my siblings, for children, and everything. I don’t think most people are in the habit of disseminating that information. As a result of that, a lot of people are probably at increased risk and they’re really not aware of it.

Katherine:

Yeah. Where can patients find the most up-to-date information regarding screening?

Dr. Kamath:

The best resource, to me, is the American Cancer Society, their websites. They’re highly reliable, they’re easy to understand, and I find that they’re very balanced. They’re not going to be overly pushing one side or the other. But they’re going to be evidence-based. As we all know, there is so much fake news and misinformation out there, especially when it comes to health. I think having a resource you could really trust and understand is key and the American Cancer Society, you find, is an excellent resource.  

Why Are Colon Cancer Cases in Young People on the Rise?

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Why Are Colon Cancer Cases in Young People on the Rise? from Patient Empowerment Network on Vimeo.

Why are colon cancer cases rising among young people? Dr. Suneel Kamath delves into the risk factors, early symptoms of colon cancer, and the importance of consulting with your doctor.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Research Advances in Colon Cancer Screening and Detection

Research Advances in Colon Cancer Screening and Detection

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

 What Is the Role of Genetic Testing in Colon Cancer Care?

What Is the Role of Genetic Testing in Colon Cancer Care?

Transcript: 

Katherine:

Well, colon cancer cases in young people are on the rise. Do we know why this is happening?  

Dr. Kamath:  

Yeah, honestly, we really don’t to this point. We have a lot of hypotheses that we’re investigating to get to the bottom of that but it does seem like some of the usual risk factors for developing colon cancer later in life are still true. Obesity, sedentary lifestyle, a diet that’s high in red meat, processed foods. I do think to some extent the fact that we’re doing these things earlier and earlier in our lives. I think we’re seeing that the rates of obesity and overweight are not just increasing but they’re also occurring in people’s teenage years and in their 20s and 30s.  

It’s a time dependent process. I do think some people being at a higher than healthy body weight and leading a sedentary lifestyle starting at age 10 may lead to a cancer by age 30 or 40. I do think that’s part of it. But I do think there’s probably some other undescribed factor. We know plenty of people who come in who are runners and healthy, and honestly they’re healthier than I am to be honest with you and they still develop this for no reason. I am sure there’s some other exposure that we still need to identify.  

Katherine:  

What symptoms should young people be paying attention to?  

Dr. Kamath:  

It’s a great question. Fortunately, with early onset colorectal cancer, it’s much more likely to be on the left side of the colon, or closer to the exit, if you will. 

The good thing about that is the symptoms of it can be a little bit easier to detect. A lot of people describe to me that they have more blood in their stool. They found that they were straining harder than normal or having had a thinner stool caliber. I would also emphasize that these are often symptoms that go on for weeks and months at a time. All of us might eat the wrong thing for a day or two and get some stomach issues here or there so I don’t want people to overreact to every little symptom.  

Certainly, if you’re having constipation that’s going on for several weeks in a row, that’s often not going to be a benign thing. If you have that type of symptom and it’s persistent, definitely talk to your doctor and get it checked out.  

Research Advances in Colon Cancer Screening and Detection

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Research Advances in Colon Cancer Screening and Detection from Patient Empowerment Network on Vimeo.

What are the latest research advances in colon cancer screening and detection? Dr. Suneel Kamath explores cutting-edge screening modalities, including a noninvasive test and innovative blood tests.

Dr. Suneel Kamath is a medical oncologist at the Cleveland Clinic Taussig Cancer Center. Learn more about Dr. Kamath.

See More from DETECT Colon Cancer

Related Resources:

Why Are Colon Cancer Cases in Young People on the Rise?

Why Are Colon Cancer Cases in Young People on the Rise?

 What Are Colon Cancer Screening Guidelines?

What Are Colon Cancer Screening Guidelines?

 What Can Patients Do to Access Better Colon Cancer Care?

What Can Patients Do to Access Better Colon Cancer Care?

Transcript: 

Katherine:   

The American Society of Clinical Oncology annual meeting just wrapped up. What were the highlights from the meeting related to colon cancer screening and detection?  

Dr. Kamath:  

This was some evidence that came out prior to the meeting but there was quite a bit of buzz about it at ASCO itself. There’s a number of new screening modalities that have obtained their FDA approvals or have had major data releases for, which have looked extremely promising. The first one that comes to mind is the ColoSense test. This is an RNA-based stool test. It’s a stool test similar to Cologuard but it’s a slightly different technology where it’s using RNA instead of DNA like Cologuard did.  

Similar to many of the other tools, it’s showing excellent performance in terms of how sensitive it is to detecting colon cancer. They showed in a prior publication they could detect almost 95 percent of colorectal cancers. It was also a rather specific test, too, so 88 percent specificity. What this is telling us is that this test if very good at detecting colorectal cancer when it’s there but also, equally importantly, it’s very good at not giving you a false positive, which is also very important with any screening test.  

So, we’re really excited to see that. We’re increasingly thinking about noninvasive ways, beyond colonoscopy, that we can improve colon cancer screening.  

Katherine:  

How does it compare with Cologuard, then?  

Dr. Kamath:  

This one is called ColoSense, yeah. I would say both of these numbers in terms of the sensitivity, meaning that’s the level of detection. If someone does have colorectal cancer, how well do you detect that. That sensitivity of almost 95  percent is definitely a little bit higher. Specificity is also, I would say, a little bit higher. I do think that this test would likely both detect more colorectal cancers that Cologuard would and it would also give you fewer false positives at the same time.  

Katherine:  

And is this going to be something that people can take the test at home?  

Dr. Kamath:  

Yes. This should be because it says a stool-based test. I’m sure a lot of the logistics would still need to be worked out, as with any new test. Having the kit sent to the primary care doctors’ offices and things like that. Arranging for that infrastructure, I’m sure, will take some time. But, yes, this test is pretty easy and simple to do. It should be the same as sending in any other stool-based test into a lab.  

Katherine:  

Is there other research you’re excited about?  

Dr. Kamath:  

Yes. Another one that I’m really excited about is there are these blood-based screening tests as well. A couple are coming to mind. One is from Guardant Health. They have been developing this assay specific for colorectal screening for some time. They’ve also been talking about their data for a blood-based test.  

For them, the number is also still quite good. They’re saying that the sensitivity is about 83%, so maybe a little bit lower than the RNA one but specificity is 90 percent. So, maybe actually a little bit better with that. So, I’m very excited about this one because this is a blood-based test that could be done at a doctor’s office. We all know practicalities are if you can just order a test in the lab and have someone get a draw the same as getting your lipid panel checked or other things that are routinely done, that’s very easy to do and you can be pretty certain someone’s going to follow  through on that.

Whereas, we know with these stool-based tests, it’s about a third to half of patients, even though you send them home with a kit, you may not get the specimen back at all.